Invictus Reviews
Get ready for something new in the board review universe! A free podcast featuring the legendary Mel Herbert and crew. We're diving into the essentials for crushing the Emergency Medicine board exams—whether you're just starting out or mastering the advanced stuff. Brought to you by the same brilliant minds behind EM:RAP, CorePendium, and UCMax. 🚀
Coming soon to: Invictus.reviews
Invictus Reviews
Mastering Medical Board Exams: Strategies and Techniques
Discover the secrets behind mastering medical board exams with Mac Brown, a core faculty member at John Peter Smith Emergency Department. We promise you'll come away with innovative strategies that maximize your limited study time without sacrificing your well-being. Mac introduces his unique "candle making method," a study technique that focuses on building a solid foundation through consistent, small study sessions tailored to your individual learning style. Whether you're a fan of podcasts or prefer question banks, Mac's insights will help you integrate these tools into your routine, making exam preparation a seamless part of your daily life.
In an era where medical exams are shifting toward simulation-based assessments, Mac guides you through advanced techniques to tackle these stress-inducing formats. Learn how to identify and fill knowledge gaps, enhance memorization of critical medical topics, and maintain a balance between study and self-care. As your career hinges on high exam scores, especially in high-pressure roles like those in emergency departments, these strategies become crucial. Join us to glean practical advice and innovative tools that ensure not just passing, but excelling in your medical board exams.
Link to the CorePendium Study Guides
My name is Mac Brown. I am a core faculty at the John Peter Smith Emergency Department with a residency. I'm also Jess Mason's medical education fellow in my second year.
Speaker 2:So let's talk about exam prep and let's talk this time specifically, mostly to the residents how you get the most out of your residency. Very difficult time, very little time. How do you use that time to consolidate an enormous knowledge base so that you can go crush the exams? So we'll be talking about how to use study guides, how to use questions, which question banks to use and a whole bunch more. And this is important because the board exam pass rate has gone way down. It has plummeted. We need to really start focusing on this, because the last thing you want to do is fail this exam after all these years of training and the expense and the psychological warfare of not passing. So let's talk about it all.
Speaker 1:You're in Texas, yes sir, I'm in the old, the great Yeehaw state.
Speaker 2:Are you a Texan by birth or did you just end up there for residency?
Speaker 1:I grew up initially in Illinois, I went to college in the state of Washington and then I spent a couple of years in Arizona, california, ohio, and then I went to med school in Omaha, nebraska.
Speaker 2:Wow, you've been around.
Speaker 1:It's fun to explore. Omaha is definitely not fun, but it's great to study in.
Speaker 2:Well, it turns out we're doing this Board of View course and I was talking to Jess Mason about it. She's like you got to talk to Mac Mac's all about the Board of View. He's really into this. So here we are. One of the things we want to do is not just a Board of View course but a continuously revised Board of View course, sort of an MRAP for Board of View, and one of the things that already has come up from a lot of people is please give us a guide to how to study for residency, how to study for boards, space repetition. You're all sort of everybody does the same thing. They throw up a board review course and say here it is, see you later, and nobody really goes through what they should be doing during residency and then how they should be keeping up. So you've got some thoughts on this. Tell us what the hell they are.
Speaker 1:This is kind of a trial and error of stuff I've done but with myself and then with my residents that I kind of coach and support. The biggest thing in residency is just staying sane. You get beaten down so hard by the world constantly. You're working 70 hour weeks every week, having to deal with all these different admin projects, and you also have to like bathe and shower. I remember on MICU all my clothes I would wash, I would just put on my couch because I just didn't have like the gall to fold them, so I just lived off my couch for that whole month. Like breaking down the hours wise, if you work 70 hours a week it kind of starts kind of piling on. So in a week you have 168 hours. If you break that down, take out the hours of work, you have 90 hours. If you sleep seven hours a night, you have even less. Yada, yada, yada. You leave to about probably anywhere between two to three hours of free time a day. That's not involved showering, sleeping, feeding yourself, taking care of family pets, all that stuff you know. And it's super important to kind of utilize that time as best as you can, and so this method that I kind of put together allows you to kind of maintain that without getting beaten too hard.
Speaker 1:Some people have called it, like colloquially, the trickle method. I think that's a little bit like not quite as accurate. I like to call it the candle making method. When I was in third grade we had to learn how to make candles because we had like a big pioneer thing and I always thought it was super cute. You know, you have to like dip the candle in the wax and take it out, let it cool so it adds on over time and if you do it over like a minute or two, you only see a little bit of progression. You do it over like half an hour. You have this big old honking candle and all of a sudden you can you know light that sucker up for a couple hours and then read, and you know, read on the prairie. Entire goal of this kind of study plan is to do it little by little and to spend maybe half an hour to an hour five days a week and then, over the additive accumulation of everything over the course of a year, you end up having, hey, 365 hours of studying. If you do an hour every day, that's not realistic. Probably closer to like 200 hours of studying.
Speaker 1:If you maintain sanity, you take some time off for your MICU, your surgery rotations, those kind of things, and so you kind of want to maximize your time and minimize the fluff. So in maximizing your time you want to focus and have a plan going in. So when I have my residents I kind of write down exactly what they should be doing and I talk to them to see how they learn the best. So if you're a podcaster person, hey, guess what MRAP's perfect for you. So I'll have them usually pick out a topic or two based off what they saw previously and enlist in that topic or read about it in a textbook or something along the lines of that, and that gives them the on-shift clinical knowledge of hey, I wasn't sure how to approach this choledocholithiasis. I'm going to read about this today. In conjunction with that, I have them do one or two every time they study.
Speaker 1:I recommend to do probably 10 to 20 questions of like a Roche, peer, uworld. Generally my residents use Roche, but Peer is fantastic as well. Uworld is not as utilized in emergency medicine if you're studying for your like step three or the DO comparative as well. Uworld is not as utilized in emergency medicine if you're studying for your like step three or your the DO comparative as well. Uworld is kind of the go-to for that. On top of that, I recommend residents use a baseline curriculum like Corpendium's curriculum. Most of my residents will utilize that because it gives them a longitudinal approach and allows them for a more complete educational. No one else does that kind of study guide besides your residency, and your residency may have holes. That's difficult to fill and find and the study guides are pretty much ACGME. It has almost everything on there, if not everything on there, that the ABEM recommends.
Speaker 2:Let's stop there for a second. So these study guides can be found in Corpendium. They are under the title study guides and their first, second, third year. We didn't create one for fourth years because we figure at that point it's a choose your own adventure For first, second and third year. They're really extensive and they're revised every year and I think now you and Britt are now taking that over from Witt Johnson to continually revise those. So you've got C3 content, you've got MRAP content, you've got EMA content, you've got everything. Plus you have obviously the textbook. So that's one way to go through it, Basically start at the beginning and go all the way through the three years. Is that how you think about it?
Speaker 1:I would recommend that. The problem with that if people study on their own, there will be knowledge deficits and holes that they just won't have. They won't be able to fill those. Well, If they just do Roche questions, there'll be a lot of gaps in their knowledge because, hey, they can do a bunch of questions and probably ace the test, but hey, they may not know how to approach this very specific disease process if there's no question on it and then same with, like, the clinical competencies.
Speaker 1:If you don't know the super fine details of respiratory acidemia and how to approach you, know someone with like a acute hypercapnia. That's a big clinical deficit you need to fill. So but kind of utilizing those three facets of it, you kind of make a your own complete approach to emergency medicine and kind of how I let my residents know how to do this is just get yourself set up where, hey, I'm going to do one topic, do 10 to 20 questions and then I do a little bit of time here on this week with the corpendium and that way they kind of fill in everything that they would need and then over the course of a year you already see like the scores jump up if they're into it. The classic textbook reading is what people used to do. It's not as efficient like using Bloom's educational pyramid. Reading is only, like usually leads to poor knowledge. It's harder to maintain that. So by using the testing you're able to kind of make it active and analyze and figure out your deficits and then having that repetition as well.
Speaker 1:Space repetition is amazing. Realistically, just really sticking with it's the most important thing. It doesn't matter if you do a little bit less one week and a little bit more the other week, but just do a little bit over. Time is so vital to studying in residency and maintaining sanity. Now you don't have to do three hours one day. If you half an hour five days a week, you're so much better off Because it's still. It's all about the additive time. You're making your candle of knowledge, so when you burn it on the test, you can just burn and go.
Speaker 2:So let me just jump in here and add to that, although reading itself is not the best way to consolidate knowledge, it really is still the best way to consolidate knowledge. It really is still the foundational way to do it. So I agree, go and read a little bit every day. But then if you want to consolidate that knowledge, you've got to talk to somebody about it, you've got to do some questions about it, and then we're going to talk about it in a second. You've got to go back and read it again, not necessarily the whole thing, but a summary form of it.
Speaker 2:But it all, for me, begins with making sure you're reading or doing a reading equivalent, which, if you have difficulty reading, like I do, you can use sort of audio. And that's what MRAP's really great at. And specifically I'd say, for the residents listening to this, the students listening to this, you want to listen to C3. C3 is the approaches to a lot of common patient presentations. Mrap itself tends to jump in a bit too high a level. Ema is really great when you're further along in your residency talking about the baseline literature of emergency medicine. But the stuff you want to be listening to initially is C3, while you're reading those textbook chapters.
Speaker 1:For the listeners that don't know what spaced repetition is. It's essentially just you review one topic one day and then you review the topic again a couple days later. So hey, I saw choledoglithiasis on Monday. I'm going to read about it on Wednesday. Or hey, I got this question wrong on Rosh on Monday, I'm going to review the Rosh block. And that way you have a little bit of time between you, have a couple of sleeps on it so you can kind of really really memorize that information better and learn it better.
Speaker 1:And if you look at kind of the hour by hour, or you do 10 questions a day, you do one topic a day and then you listen to one podcast a day and if you do that probably for 40 weeks of the year, you end up you do probably the whole 2,600 questions. 1,800 questions and you have well over 30. A couple hundred topics that you've reviewed and listened to. And that is humongous when most of the residents that I have they don't really have a good study plan. They may not study at all or they may just study and cram for the ITE. But with the new board passing rate being like 80% for all takers, this is no longer efficient. This is no longer a way to pass, and when your licensing's on the line, I really want to make sure that my residents are set up for success.
Speaker 2:So I talked about it at the beginning, but let me talk about it again now. So the board pass rate really has gone down an enormous amount. I do not know why I find the students and residents today as smart or as smarter than at any time, but the exam pass rate has gone down. Has it gotten harder? I don't know. But that makes this even more important, and there's some more on spaced repetition. So you have to consolidate your knowledge.
Speaker 2:It is the rare, rare, rare person that reads something once or hears it once or has a discussion about something once and it goes into their long-term memory. The vast majority of us actually have to do something like read it now, read it in 24 hours, read it in a week, read it in a month, read it in six months, read it in a year, or read or listen to. So it's not just once for most of us and you probably at this stage know who you are. But if you're an average clinician, physician, physician to be, don't be surprised by the fact that you have to go over stuff multiple times. Even though as a group, very smart, good memories, still most of us have to go over things multiple times. You've got three or four years of residency and you've got to use that time to go over it multiple times. Initially you can go over it at a more superficial level and then each time you can go a little bit deeper. But that's why it's good to do grand rounds, that's why it's good to listen to stuff and read stuff and do multi-guest questions. And I suggest you keep a log. Keep a log of what you've been studying so that you can flip back and go boy, I haven't looked at that in a month or two. Let me just see if I still know that and at that point do some questions on it or just go back and read a summary on it, something like that let's talk about in air quotes.
Speaker 2:Teaching for the exam and a lot of people get agitated like you should not teach for the exam. And I say that's absolute crap. If you're going to have these exams at the end of a four-year residency, after 12 years of college and med school and huge financial burden, you better damn study for the test. So let's get that out of the way here. Study for the test. That knowledge will be useful. It is not the only knowledge you need. You want to pass this thing the first time and get it over with.
Speaker 1:And it's so, it's. It's so huge too because it's a thousand dollars I at least to take your boards. And then God forbid you fail it and then you have anxiety. You're like, hey, my job, you know my job may come into question all of a sudden if I can't get licensed. You know why. Why run the race and then not cross the finish line? So that's why I tell my residents, like good Lord, you guys, stay strong at the very end. One thing I did want to mention as well, just the fact that burnout is high in residency and a lot of residents will experience this.
Speaker 1:First and foremost, take care of yourself. Take care of your mental health. Never feel like, hey, I have to do excuse me, so much more studying because I have to at the extent of like, hey, like my wife, I'm not talking with her as much, or my dog's not getting walked. You know, take care of your lifestyle first and then fill in the time that you have with some studying pieces. So little stuff here and there, podcasting. If you can listen to podcasts when you exercise on your way to work, you can do some rush questions when you're relaxing, when you get home, if you're going for a night shift. Wake up, try and get your studying done before you go on the night shift. If you're in the morning shift, try and take some time after decompress and then, if you have the wherewithal to do so, do so. But just these small increments will make a humongous difference and if you track it, you'll see them just pile up and pile up. You know.
Speaker 2:So let's do an example of one of these little programs that Mac has put together.
Speaker 1:I'm going to give you guys, one that I gave to one of my residents. He had a little bit of difficulty studying, didn't do as well on port exams. So for his plan I have him doing four days a week. Well, he'll do an hour when he's on service, off service he will try and do half an hour-ish if he can. But like surgery, he has no time. Micu he has no time and he's too just exhausted to do so. So for him I have him doing one topic, one topic of review of previous things.
Speaker 1:Saw on the study guide and saying, hey, keeping up on that, and then doing 10 to 20 rush questions and then, um, in that study block it usually is about half an hour to an hour and he'll review those questions. He doesn't like the space repetition as much because he feels like it's a backtrack too much. That's okay, it's works for, and he also has a little trouble reading and kind of like maintaining that. So he'll go on runs and listen to the topics. Usually he'll use MRAP, other sources as well, but that's what he does. And he's been doing significantly better. His board rate or his IT scores and his Roche testing scores have gone significantly higher and his clinical accuracy has gotten better too. But the combination of things, that little bit here and there for him, is making a humongous difference, and that's what.
Speaker 1:I've written for him and he likes it. He's sticking with it. Realistically, everything. It doesn't matter what you're doing If you're not sticking with it. That's the most important thing is just consistency and sticking with it.
Speaker 2:And this is very similar to what we hear from the language learning programs. There's a lot around that a little bit every day turns out to be incredibly powerful than binging. When it comes to trying to learn stuff, binging is not as good as a little bit every single day, or as close to every single day as you can.
Speaker 1:My Duolingo bird looks like he's withdrawing right now. I haven't seen him in a couple of weeks. I feel bad for him.
Speaker 2:Yeah, it's so funny. Yeah, because Duolingo if you don't know it is the world's biggest language learning program, and if you don't visit Duolingo every day, he starts to melt and gets a sad face. That's to encourage you to do more studying. Now word about Qbanks. There's so many Qbanks. Roche is obviously a big one. It's been around a long time. People really like it.
Speaker 2:I also strongly suggest that you do peer questions, suggest that you do peer questions.
Speaker 2:The peer questions and the ABIM questions are very similar, and here's another way you can get a whole bunch of questions if you're really into that, and that's by using ChatGPT.
Speaker 2:So go to Corpendium, download the chapter say Myosinograppus I'm just working on that right now Stick it into ChatGPT and use a prompt, something like make 10 questions from this PDF and make them at the level of the American Board of Emergency Medicine exam and give me the explanatory answers and about 10 seconds later there will be 10 questions. My experience is that they are mostly extremely good and every now and a hallucination, and so it's actually something that you need to check. You need to go back and check well, is that answer really right? But that process as well can help you consolidate the information. So that's a quick and dirty and actually very inexpensive way of doing that. We're going to be doing that on our program, we're going to be doing that and we're going to be checking them and we're going to be putting them up on the site so that you can have, you know, human checked, ai generated questions, but at a fraction of the price that everybody else uses. But again, I do suggest, I strongly suggest, that you do the peer as well, do those peer questions.
Speaker 1:I will say, if you are taking the in-service exam shortly enough, this is not going to really apply to you, because now it's more of like a cram situation. But instead of doing the extra learning and stuff, just transition more to doing more rush questions or more peer questions or whatever question make you have. Or, like mel saying, use the chat gpt and kind of help yourself, make your own and build it that way. Try and build your test stamina, because it is a longer test and if you're used to doing 40s, usually by the time you get to like 130, 140 questions, your brain kind of starts going. You know like oh, you know what's going on and I want to check facebook, I want to take a nap, kind of thing. So you gotta build up that test stamina too. You're taking your actual boards. Make sure you bring, like food, snacks, caffeine, because I was essentially like vibrating. I had so much caffeine in my system because I get real tired after like 200 plus.
Speaker 2:So yeah, that's a really good point, that it's sort of like a marathon. If you don't train for a marathon, you're not busting three hours in that marathon just not going to happen. So I don't think you need to do it every week or anything like that, but doing an actual exam a few times just to to develop the sense of how long this thing takes I don't know anybody that really doesn't have enough time. It's just that you kind of get tired. So practice it like do it so that you can then take a 10 minute break or a five minute break where you just sit there and just like chillax and then go back to it again, develop some skills about getting through it. The other thing that Billy points out which I think is really important is if you don't know the answer, don't stick with that question for 20 minutes. It's like I have no idea, just like okay, you got me. Next question, see.
Speaker 1:I'm a big fan of like marking and then going back later and at the very end I'm like I have no idea, just skip it and just send it. You know, go back later.
Speaker 2:What about the idea of doing a question bank, initially finding where you're worst and concentrating there. Is that something you teach your residents Like? Okay, you know cardiovascular fantastic, but your PEDS is horrible. I want you to focus on PEDS.
Speaker 1:Depending on the person. If you do enough of the studying and baseline stuff you'll build up. Your weakness is pretty good. But if there's an obvious large deficit, I know one of my residents really struggled, for whatever reason, with H-E-N-T. So I just had them focus, read more topics, listen to more topics on this kind of thing. By the end of the day, try and memorize those patients a little better.
Speaker 1:But nearing testing time, if you're struggling with a specific piece or specific topic, do extra questions on that and just see where your deficiencies are. Same with feedback you only really know where your deficiencies are by being told where they're at. Because you don't know, you can't see them. And a test question gives you instant feedback as to, hey, I have no idea how to treat you know, vermilion border lacerations. Do I just glue them together? That kind of thing. And if all else fails, if you do them more, so near the end, you can kind of sometimes memorize a little better. Instead of learning it, you memorize hey, this is what you do for this. Or like Laforte fractures one, two and three. I still have trouble memorizing those, but if I review them near the end, I have a better chance of memorizing them prior to the test.
Speaker 2:Well, mac, this has been fantastic. We'll get you back because I want to talk about this new part of the exam which is freaking a lot of people out, which is sort of the oral exam the classic oral exam is going away, which was always very stressful.
Speaker 1:Now they've replaced it with something that sounds like it's even more stressful, like an oski, like exam. Yeah, nothing like good old-fashioned simulation on someone that's, you know, has chest pain. But they're sitting there staring at you with a blank face yeah.
Speaker 2:so we'll talk about that too, because this, what we're talking about now, is basically just getting through that didactic portion and then we'll come up with a plan with how to prep people for that more hands-on, oral-like examination. So thank you for your time, sir. Right now we should timestamp this. There are fires throughout Los Angeles. It's pretty freaking bad, and you're in Texas and you're about to get snow in Dallas, which never happens. So if you could send us that snow, we could really use it right now.
Speaker 1:Yeah, get some buckets, start commuting that over.
Speaker 2:And you know where all those people are going to go with their asthma and their inhalational injuries. They're going to come to you in the emergency department. So you get to work 24-7, 365, even when the shit hits the fan, and that's why your job is so important. So let's knock these exams out of the way. Let's get giant scores and move on with the real thing.
Speaker 1:Thanks, mate, all about it, thank you.